Investment in roads and traffic safety: linked to economic development? A European comparison

This study analyzes how economic resources invested in roads may affect mortality, depending on the level of economic development of a country. To this end, 23 European countries were classified into two groups-high-income countries and low-income countries-according to their average Gross Domestic Product (GDP) per capita over the period 1998-2016. The economic resources are considered through the investment in construction and the maintenance expenditure. Further variables are included to control for several factors related to the infrastructure, socioeconomics, legislation, and meteorology. Fixed-effects panel data models were built separately for the interurban road network of each group of countries. These models also capture the international inequalities within each group and the country-specific national trend for the study period. The main results indicate a reduction effect on the fatality rate of road maintenance expenditure (in both groups), and of the investment in construction (in the low-income countries). Other variables-such as proportion of motorways, motorization rate, unemployment rate, GDP per capita, alcohol consumption, Demerit Point System, and mean annual precipitation-showed statistically significant results as well. Finally, the country-specific fixed effects and the country-specific trend were mapped geographically, to better reflect national conditions for achieving lower fatality rates in the high-income countries, and greater progress in reducing fatalities in the low-income countries. In the end, this study provides evidence to policy-makers that can help to achieve a safer and more sustainable transport system, namely, how to tackle an ongoing major problem-traffic-related deaths-when attending and allocating the economic resources that road infrastructure needs.

The Gender Gap in Life Expectancy in Urban and Rural China, 2013–2018

Background

Gender differences in mortality are embedded within mortality transitions. Rural residents generally lag behind their urban counterparts in the transitions. The study objective is to identify major causes of death that drive gender differences in mortality in urban and rural China.

Methods

We use age-, gender-, urban-rural- and cause-specific mortality data (2013–2018) derived from the national mortality surveillance system that covered about 24% of the Chinese population. We apply Arriaga's method to decompose age- and cause-specific contributions to the gender gap in life expectancy at birth. Analyses are stratified by urban-rural residence.

Results

Women had a higher life expectancy at birth than men in both urban and rural areas. Cancers, cardiovascular disease, external causes, and respiratory disease accounted for more than 90% of the gender gap in both areas during 2013–2018. In urban areas, the gender gap decreased from 5.17 years in 2013–2015 to 4.98 years in 2016–2018. In rural areas, the gender gap stayed rather constant (2013–2015: 5.68 years; 2016–2018: 5.65 years). Traffic accidents, among external causes, contributed the most to decreasing the gender gap (urban: −0.07 years; rural: −0.10 years), especially in the 0–44 age group. However, the decrease in the gender gap was counteracted by an increase in the gender gap attributable to ischemic heart disease (urban: +0.05 years; rural: +0.08 years) and lung cancer (urban: +0.02 years; rural: +0.05 years) in older age groups. The gender gap attributable either to cerebrovascular disease or to chronic lower respiratory disease decreased in urban areas but increased in rural areas.

Conclusions

The urban-rural variations in the cause-specific contributions to the gender gap in China suggest the necessity of implementing urban-rural-specific interventions to improve population health and health equity.

Impact of socioeconomic and transport indicators on road safety during the crisis period in Europe

The risk of being involved in a road crash is typically influenced by mobility, which in turn is influenced by various socioeconomic indicators. This study aims to investigate the impact of socioeconomic and transport indicators on road safety during the economic crisis period in Europe. A database containing Human Development Index (HDI), suicides, passenger-kilometers and road fatalities per population was developed. Linear Mixed Models were applied for all the examined countries and the different groups that were selected for the period 2006-2015. The results led to the conclusion that HDI has the most important impact and its increase leads to road fatalities decrease. Moreover, the evolution of human development affects the outcomes of road crashes more than suicides and passenger-kilometers travelled. After the end of the crisis, the impact of human development is even higher. Concerning passenger-kilometers travelled, there is an increase in the relative impact on road fatalities after the end of the crisis.

What can we learn from the historic road safety performance of high-income countries?

Road traffic deaths in high-income countries (HICs) have been steadily declining for five decades, but are rising or stable in low- and middle-income countries (LMICs). We use time-series cross-sectional methods to assess how age- and sex- specific death rates evolved in 20 HICs during 1955-2015, controlling for income, population density and urbanization. Past work has attributed improvements in safety in HICs to income growth, suggesting that countries intervene when they become richer (Kuznets hypothesis). In contrast, we show that HICs had statistically significant declines in road traffic injuries starting in the late 1960s that persist after controlling for income effects, and inclusion of a lagged dependent variable. These findings are consistent for all age-sex groups but the effects are strongest for the elderly and young children. We argue that the reversal in the traffic injury trend did not occur because HICs reached an income threshold. Instead, the 1960s were a period of paradigmatic change in thinking about road safety. Subsequent, safety improvements occurred because countries at different income levels established regulatory institutions that had a legislative mandate and financial resources to conduct large-scale safety interventions.